Glucagon is reported to relieve esophageal food impaction in 37 - 75% of cases, presumably due to immediate esophageal smooth muscle relaxation. We report our experience on the use of glucagon for esophageal coin dislodgement in children with recent (<12 hour) impaction over a 24 month period in a tertiary referral hospital. In a retrospective study we compared 17 cases aged 1.8 to 7.5 yrs, who received 1 mg IV or SC glucagon and offered water in upright position, with 25 cases aged 1.8 to 8 yrs with esophageal coin impaction who did not receive glucagon. Results: 6/17 (35%) of the treated group had their coin dislodged into the stomach on repeat X-ray, compared with 1/25 (4%) in the untreated group (p=0.012, Fishers). The control group included 7 without repeat imaging but at endoscopy still had esophageal impaction. In the treated group, 13/17 impactions were in the lower 2/3 esophagus, compared with 8/21 in the control group, with 4 not clearly recorded (p=.05 Chi). Only side effect seen was vomiting without sequelae following iv glucagon in one patient. All responders successfully passed their coins in stool. At endoscopy, 2/11 given glucagon but had failed to dislodge on repeat X-ray, and 3/24 controls had coins in the stomach (n.s.). Conclusion: Glucagon given for esophageal coin impaction was associated with a significant reduction in need for endoscopic removal. Lower esophageal coins in the treatment group, and water taken in upright position may be an important confounding factors. The estimated cost saving is over$2000 per case. In addition successful cases avoid risks of sedation, anesthesia and endoscopy. Prospective double-blind placebo controlled study is planned.